
1
Salerno University, Hematology Division, Salerno, Italy
Low molecular weight heparins (LMWH) are widely used in throm-
bosis prophylaxis in treated lymphoma patients with central periph-
eral venous device (PVD). The negative effect of heparin on
osteogenesis is known, it is not clear how anticoagulants vit K in-
hibitors act while the role of LMWH is controversial. The negative
effect of steroids on osteogenesis is also documented but there are
no data on negative synergy related to the simultaneous intake of
steroids and LMWH.
The aim of our study is to evaluate the bone events (bone
fractures) observed retrospectively in a consecutive cohort of lym-
phoma patients treated with chemotherapy (with or without ste-
roids) from January 2014 to January 2021 with at least 6 months of
follow‐up.
From January 2014 to January 2021 we observed 197 pa-
tients with a median follow‐up of 38 months (range 6‐85 months);
90 with NHL treated with CHOP or similar 34 f and 56 m with a
median age of 59 years (range 23‐77 years); 53 with NHL treated
with bendamustine based therapy; 23 f and 30 m with median
age of 65 years (range 42‐81 years) and 54 with HD treated
with ABVD or similar; 26 f and 28 m with a median age of 34
years (range 16‐75 years). All patients with PVD and all treated
in prophylaxis with LMWH (enoxaparin or nadroparin) 4000 U /
day.
In the NHL group treated with steroids and LMWH the
observed bone events (bone fractures) were 13 (14.5% of patients).
All patients had vertebral involvement and in 2 patients in addi-
tion to the vertebral problem, an event in the femur was docu-
mented. In the NHL group treated with LMWH but not steroids, the
observed bone events were 2 (3.8% of patients) while in the
HD group there were 2 (3.8% of patients), all with vertebral
involvement.
These data show a higher incidence of bone events in patients
receiving steroid and LMWH therapy. This evidence suggests a
negative synergism between the association of steroids and LMWH
on bone metabolism and also probably confirms that vitamin D
metabolism in patients with aggressive NHL may be implicated in the
prognosis of these lymphomas.
This evidence suggests the need to integrate vit D with or
without calcifying into the therapy of patients with aggressive NHL
and to evaluate the possibility of proposing prophylaxis for throm-
bosis not with LMWH but with the new oral anticoagulants.
A prospective study is needed which also includes the study of
calcium metabolism and bone mineralization both at diagnosis and
over time in the various subtypes of NHL and which supportive
treatments they have received.
EA – previously submitted to EHA 2021.
Keywords: Late Effects in Lymphoma Survivors
No conflicts of interests pertinent to the abstract.
391 |RISK OF HEMOLYMPHOPOIETIC NEOPLASM BEFORE
AND AFTER THYROID CANCER. A POPULATION‐BASED STUDY
IN ITALY, 1998‐2012
V. Mattioli
1
, E. Crocetti
2
, L. Dal Maso
1
, C. Buzzoni
2
, S. Franceschi
1
,
D. Serraino
1
, S. Vaccarella
3
, S. Ferretti
4
, S. Busco
5
, U. Fedeli
6
,
M. Varvarà
7
, F. Falcini
8
, M. Zorzi
9
, G. Carrozzi
10
, W. Mazzucco
11
,
C. Gasparotti
12
, S. Iacovacci
5
, F. Toffolutti
1
, R. Cavallo
13
, F. Stracci
14
,
A. G. Russo
15
, A. Caldarella
16
, S. Rosso
17
, A. Musolino
18
,
L. Mangone
19
, C. Casella
20
, M. Fusco
21
, G. Tagliabue
22
, D. Piras
23
,
R. Tumino
24
, L. Guarda
25
, Y. M. Dinaro
26
, S. Piffer
27
, P. Pinna
28
,
G. Mazzoleni
29
, A. C. Fanetti
30
1
CRO Aviano, Cancer Epidemiology, Aviano, Italy,
2
AIRTUM Database,
Italy,
3
International Agency for Research on Cancer, Section of Cancer
Surveillance, Lyon, France,
4
IRCCS Istituto Romagnolo per lo Studio dei
Tumori (IRST) “Dino Amadori”, Meldola, Italy‐Azienda Usl della Romagna,
Romagna Cancer Registry, Forlì, Italy,
5
ASL Latina, Cancer Registry of
Latina Province, Latina, Italy,
6
Azienda Zero, Epidemiological Department,
Padua, Italy,
7
Università degli Studi di Catania, Registro Tumori Integrato
Catania‐Messina‐Siracusa‐Enna, Catania, Italy,
8
Istituto Scientifico
Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Romagna
Cancer Registry, Meldola, Italy,
9
Veneto Region, Veneto Tumor Registry,
Padua, Italy,
10
Modena Cancer Registry, AUSL Modena, Public Health
Department, Modena, Italy,
11
Palermo and Province Cancer Registry,
Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, University
of Palermo, Clinical Epidemiology Unit with Cancer Registry, Palermo, Italy,
12
Brescia Health Protection Agency, Epidemiology Unit, Brescia Cancer
Registry, Brescia, Italy,
13
ASL Salerno, Cancer Registry, Salerno, Ita-
ly
14
University of Perugia, Public Health Section ‐Dept. of Medicine and
Surgery, Perugia, Italy,
15
Agency for Health Protection of Milan, Cancer
Registry of Milan, Epidemiology Unit, Milan, Italy,
16
Institute for Cancer
Research, Prevention and Clinical Network (ISPRO), Tuscany Cancer Reg-
istry, Clinical Epidemiology Unit, Florence, Italy,
17
Azienda Ospedaliera‐
Universitaria Città della Salute e della Scienza di Torino, Piedmont Cancer
Registry, Torino, Italy,
18
Azienda Ospedaliera Universitaria di Parma,
Parma Cancer Registry, Oncology Unit, Parma, Italy,
19
AUSL ASMN‐IRCCS,
Azienda USL di Reggio Emilia, Reggio Emilia Cancer Registry, Epidemiology
Unit, Reggio Emilia, Italy,
20
IRCCS Ospedale Policlinico San Martino,
Liguria Cancer Registry, Clinical Epidemiology, Genova, Italy,
21
ASL Napoli
3 Sud, Cancer Registry, Napoli, Italy,
22
Fondazione IRCCS Istituto Nazio-
nale dei Tumori, Lombardy Cancer Registry, Varese Province, Cancer
Registry Unit, Department of Research, Milan, Italy,
23
Azienda Regionale
per la Tutela della Salute, North Sardinia Cancer Registry, Sassari, Italy,
24
Provincial Health Authority (ASP 7), Cancer Registry and Histopathology
Department, Ragusa, Italy,
25
Agenzia di Tutela della Salute (ATS) della Val
Padana, Mantova Cancer Registry, Epidemilogy Unit, Mantova, Italy,
26
Siracusa Cancer Registry, Health Unit of Siracusa, Siracusa, Italy,
27
Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento,
Italy,
28
ASSL Nuoro/ATS Sardegna, Nuoro Cancer Registry, RT Nuoro,
Nuoro, Italy,
29
Southtyrol Cancer Registry, Bolzano, Italy,
30
Health Pro-
tection Agency, Sondrio Cancer Registry, Sondrio, Italy
SUPPLEMENT ABSTRACTS
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